first look at mds 3.0 version 1 · 3/15/2019  · pdpm payment with entry of icd-10-cm code b20...

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First Look at MDS 3.0

Version 1.17

Mary Madison, RN, RAC-CT, CDP

Clinical Consultant – Briggs Healthcare®

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©2019 Briggs Healthcare

General Notes

Please enter your

questions into the

Question box in the control

panel on the right side of

your screen. I’ll answer a

few questions at the end,

time permitting, then

provide all Q&As in a

document to be posted at:

https://briggshealthcare.blo

g/category/webinars/

On slides with 2 text boxes

as this slide is, the left text

box shows the current

MDS item; the right text

box shows the updated

item for v1.17

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Agenda

� version of the MDS 3.0 Item Set that will

be used effective October 1, 2019• What’s changed from the current version

• What’s new in the DRAFT version

• What’s happening in A0310B

�MDS items that relate to PDPM reimbursement

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Goals

• See what the DRAFT item set looks

like

• Begin education & preparations for the

significant changes coming October 1st

• Anticipate release of the DRAFT RAI

User’s Manual

• Provide resources to utilize for

education and websites to follow for

updates as we move from DRAFT to

FINAL

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Each year on October 1st, CMS makes changes to the MDS Item Set

Some of the changes are for:

� Clarification

� IMPACT Act of 2014

� SNF Quality Reporting Program

� Requirements of Participation (RoPs)

Version 1.17 is seeing changes this year because of PDPM, IMPACT Act and SNF QRP

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Importance of the MDS Item Set

• PDPM reimbursement is established solely from the

MDS Item Set (special 18% add-on to the nursing component of

PDPM payment with entry of ICD-10-CM code B20 [AIDS] on the claim if

your state does not allow you to code AIDS in Section I); State-

specific Medicaid case mix also based on MDS Item

Set

• SNF QRPs and QMs (with exception of claims-based

measures)

• Survey

• Nursing Home Compare

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Item Set Changes

• Eight OMRA Item Subset Codes (ISCs) have

been removed: NS, NSD, NO, NOD, SS, SSD,

SO, and SOD

• Two new ISCs have been added: the Interim

Payment Assessment (IPA) and the Optional

State Assessment (OSA)

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New Item – A0300Optional State Assessment

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Revised Items - A0310B, C, DType of Assessment - PPS

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New Item – A0310G1Type of Assessment – Interrupted Stay

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Revised A0600BMedicare Number

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Revised Item - A1500Preadmission Screening & Resident Review

(PASRR)

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Revised Item - A2400Medicare Stay

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Items Removed from v1.17Safety Notification

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Revised Item – E0900Wandering – Presence & Frequency

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Revised Item - GG0100Prior Functioning: Everyday Activities

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Revised Item - GG0110Prior Device Use

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New Column for GG - IPA

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New Column for GG - IPA

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Revised & Added Items - I0020Active Dx – Primary Medical Condition

Category

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Item Added to NQ, NP & SP –

I1300

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Revised Item - I5900Bipolar Disorder

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Revised Item – J1800Any Falls Since Admission/EntryD

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New Item – J2100Recent Surgery Requiring Active SNF Care

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New Items When J2100 = 1Health Conditions – Surgical Procedures

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AndD

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Revised Item - K0510Nutritional Approaches

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Revised Item - K0710Percent Intake by Artificial Route

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Item Removed from O0100Respite Care

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New Items – O0425Part A Therapies

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New Item – O0430Distinct Calendar Days of Part A Therapy

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Item Removed – O0450Resumption of Therapy

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Removed Items - V0100Items from Most Recent OBRA or Scheduled

PPS Assessment

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Revised X0600BCorrection Request – Type of Assessment:

PPS

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Items Removed – X0600C & DCorrection Request – Type of Assessment

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Item Removed – X0900Reasons for Modification

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Item Removed – Section ZAssessment Administration

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Revised/Removed Items –

Section ZAssessment Administration

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Nutritional Status – Revised

CAT Trigger

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Did You Know?

• 74,000+ ICD-10-CM codes mapped in

MDS software to calculate therapy

payment components (RTP codes

cannot map to PDPM)

• 28,000 configurations of PDPM payment

based on MDS item coding

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Now What Do I Do??

• Share the presentation & handouts with all staff on your team.

• Watch for the May release of the RAI User’s Manual for October 1, 2019. Remember you MUST use the 10/1/2018 RAI Manual through September 30th.

• Review the new and updated items guidance in the 10/1/2019 RAI User’s Manual. Involve your team!

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And???

• Start attending PDPM education sessions – include all team

members that will be involved in the MDS coding as well as

reimbursement specialists. There are lots of them out there so

participate in more than one. This is a process that will take

several learning opportunities to fully grasp what PDPM is then

refreshers to reinforce. CMS will be doing more trainings as

well.

• Remember: Heir & a spare for both MDS and reimbursement

activities/processes.

• Use the resources provided on the next 3 slides. Use the MDS

Items used in PDPM handout as a reference.

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Resources

• https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation.html

• https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/NursingHomeQualityInits/MDS30RAIManual.html

“CMS expects to post the RAI Manual in early May, 2019”

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More Resources

• www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation.html

• https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/NursingHomeQualityInits/NHQIQualityMeasures.html

• https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-

Program/SNF-Quality-Reporting-Program-Spotlights-and-Announcements.html

• https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/SNFPPS/PDPM.html

• https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/SNFPPS/Downloads/MLN_CalL_PDPM_Presentation_508.pdf

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Additional Resources

• https://www.simpleltc.com/webinar-team-approach-pdpm-registration/

• https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_InterruptedStay_Final_v3_508.

pdf

• https://www.briggshealthcare.com/19-ICD-10-Expert-for-SNF-IRF-LTCH-eBook-

OPTUM360

• https://www.briggshealthcare.com/19-ICD-10-CM-Code-Book-PMIC

• https://www.briggshealthcare.com/ICD-Expert-for-Post-Acute-Care-On-Line-1-

Year-Subscription-Optum360

• https://www.briggshealthcare.com/MDS-3.0-PremiumPlusOne-Package

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Handout – MDS Items & PDPM

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MDS Items: Depression Splits

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Mary Madison is a registered nurse with 45+ years of

experience in the healthcare field; 40 years in the

long-term care industry. Mary has held positions of

Director of Nursing in a 330-bed SNF, DON in two 60-

bed SNFs, Reviewer with Telligen (Iowa QIO),

Director of Continuing Education, Manager of Clinical

Software Support, Clinical Software Implementer

and Clinical Educator. Mary is a Certified Resident

Assessment Coordinator (AANAC) and a Certified

Dementia Practitioner (NCCDP). Mary has

conducted numerous MDS trainings and other LTC

educational sessions across the country in the past

2+ decades. She joined Briggs Healthcare® as their

LTC/Senior Care Clinical Consultant in July 2014.

Mary’s contact information is:

Madison.Mary@BriggsCorp.com

Briggs Healthcare® website:

https://www.briggshealthcare.com/

Follow Briggs Blog: https://briggshealthcare.blog/

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